Destruction of water systems directly threatens global public health

Water scarcity seldom starts wars, but wars increasingly degrade vital water systems on which health and recovery depend, creating a cycle that reinforces ongoing fragility and violence, warn experts in The BMJ's climate issue today.

Rohit Ramchandani and colleagues at the United Nations University Institute for Water, Environment and Health argue that attacks on water systems are attacks on health systems, and should be counted, contested, and prepared for as such.

Water compounds conflict but is seldom the only cause, they explain. Syria's 2007–09 drought, for example, is often cited as triggering the 2011 uprising, yet data show that agriculture rebounded strongly in 2010, and pre-war migration was largely internal, temporary, and adaptive.

Similarly, Lake Chad in West Central Africa shrank by up to 90% between the 1960s and 2000, yet violence escalated after 2010 even as water levels were stabilizing.

The danger lies less in scarcity itself than in how its costs are distributed, they write, which deepens grievances, particularly when the least powerful bear the burden of adjustment as freshwater systems fail.

They note that in 2024, the Pacific Institute recorded 420 water-related violent events, 78% more than in 2022, with 61% involving direct attacks on water infrastructure.

In Ukraine, millions struggled to access daily drinking water within months of Russia's full-scale invasion, while this year in the Persian Gulf, reported incidents included a US strike on an Iranian desalination plant cutting water to 30 villages on Qeshm Island, an Iranian drone attack damaging a plant in Bahrain, and alleged targeting of two reservoirs in Sirik supplying water to 20,000 homes.

Damaged water infrastructure often leads to health crises, they add.

In Sudan in May 2025, power plant damage cut electricity to Khartoum's water treatment stations, leading to almost 500 cholera cases in a single day, while in Gaza, roughly 57% of water infrastructure was damaged or destroyed by the end of January 2024. In the three months after the conflict escalated, WHO reported 136,400 cases of diarrhoea among children under five, 25 times the pre-war rate.

The authors outline priorities for health leaders, such as recognizing water systems as critical health infrastructure, tracking water quality, antimicrobial resistance, and related health impacts, and preparing health systems for water loss before it occurs by investing in resilient water and sanitation systems and backup supplies.

"Water bankruptcy does not make conflicts inevitable, but averting it requires honest accounting, fair renegotiation of claims, and sustained investment in peace and cooperative transboundary governance," they write.

"The evidence rejects water as a sole cause of war, but as a target of war it shows a clear pattern. Attacking water is an attack on health, and attacking health undermines peace. Whatever starts a war, water must never become its weapon," they conclude.